Τόμος 9 (1991) – Τεύχος 1 – Άρθρο 4 – Επιθεώρηση Κλινικής Φαρμακολογίας και Φαρμακοκινητικής-Ελληνική Έκδοση – Volume 9 (1991) – Issue 1 – Article 4 – Epitheorese Klinikes Farmakologias και Farmakokinetikes-Greek Edition

9: 20-30 (1991)

PHARMAKON-Press: Epitheorese Klin. Farmakol. Farmakokinet.

9: 20-30 (1991)

hyperlipoproteinemias, diet drug treatment

An abnormal elevation of either or both of the principal blood lipids, cholesterol and triglycerides is best termed hyperlipoproteinemia. Plasma lipoproteins are water-soluble complexes of high molecular weight composed of lipids and one or more specific proteins called apolipoproteins. The lipoproteins in plasma are classified into five major groups by size, density, electrophoretic mobility and composition with respect to trigly­ceride, cholesterol and protein. In descending order, ranked according to size, the lipoproteins are chylomicrons, very low density lipoproteins (VLDL), intermediate density lipoproteins (lDL), low density lipoproteins (LDL) and high-density lipoproteins (HDL). Several different lipoprotein disorders have been distinguished on the basis of triglyceride and cholesterol levels, lipopro­tein phenotype mode of genetic inheritance and when known the biochemical defect of lipopro­tein metabolism. One, phenotype may arise from more than one genetic disorder. Genetic factors are important in many of the hyper­lipoproteinemias. The differentiation of the genetic hyperlipoproteinemias from each other and from secondary hyperlipoproteinemias is difficult because no specific diagnostic test is available for any of these disorders. Both genetically acquired and secondary hyperlipo­proteinemias are characterized by similar syn­thesis and have comparable metabolic seque­lae. Despite the marked heterogenecity of the hyperlipoproteinemias and the bulk of rapidly accumulating knowledge about their pathophy­siologies, both the diagnosis and the therapy of these disorders have progressively been simpli­fied. Therapy for all the hyperlipoproteinemias involves a diet plan and the administration of drugs. The recommended diet consists of foods low in cholesterol and saturated fat and rich in fruits, vegetables and legumes. Saturated fats strongly be replaced with polyunsaturated and monounsaturated fats. Diet rich in fish oils appear to reduce the mortability from coronary artery disease. All overweight patients should be given a reducing diet. Pharmacologic agents are ineffective unless a weight-reducing diet is followed. In patients with hypercholesterole­mia, we supplement the diet with the bile acid sequestrants, colestipol and cholestyramine. The nicotinic acid is also highly effective as well as the new class of drugs like lovastatin which directly inhibit hepatic cholesterol syn­thesis. Gemfibrozil which is used mainly for the treatment of hypertriglyceridemia can be used for patient with hypercholesterolemia who do not respond to conventional agents. The same holds true also for fenofibrate. In the patient with hypertriglyceridemia a weight-reducing diet is the best means to lower the triglyceride level. Gemfibrozil and fibric acid derivatives like fenofibrate, are the drugs of choice in this  condition. Controversy however persists as to whether elevated triglycerides predispose to atherosclerotic heart disease. For the patient in whom both cholesterol and triglyceride levels are elevated concurrent dietary therapy and weight reduction serve as the basic treatment. Drug therapy may augment the effects of diet and weight reduction. The drugs of choice are gemfibrozil and the fibric acid derivatives (feno­fibrate). Nicotinic acid which can lower both cholesterol and triglycerides unfortunately can­not be used, because of the severe flushing which most patients cannot tolerate it.

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